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General NPI Number Information
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NPI Number | 1306129994
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Entity Type | Organization
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Legal Business Name | EMBRACE GROWTH COUNSELING AND CONSULTING SERVICES, PLLC
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 305 ABBOTTSWOOD DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3369
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Country | US
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Telephone | 910-227-9779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9834
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-9092
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Country | US
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Telephone | 910-227-9779
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Fax |
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Authorized Official
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Title or Position | CEO/COUNSELOR
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Name | SHENETHIA FENNER SHAW
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Credential | LCMHCS
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Telephone | 910-227-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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